Skip Navigation Archive: U.S. Department of Health and Human Services U.S. Department of Health and Human Services
Archive: Agency for Healthcare Research Quality www.ahrq.gov
Archival print banner

This information is for reference purposes only. It was current when produced and may now be outdated. Archive material is no longer maintained, and some links may not work. Persons with disabilities having difficulty accessing this information should contact us at: https://info.ahrq.gov. Let us know the nature of the problem, the Web address of what you want, and your contact information.

Please go to www.ahrq.gov for current information.

Your Medicine: Be Smart. Be Safe. List of Doctors and Pharmacists (DOC)

You can learn more about how to take medicines safely by reading this guide. It answers common questions about getting and taking medicines and has handy forms that will help you keep track of information.

List Your Doctors and Pharmacists Here

Keep this guide with your medicines in case you have any questions, concerns, or worries.

Doctor: _______________________________________________________________
Contact Information: ________________________________________________________________

Doctor: _______________________________________________________________
Contact Information: ________________________________________________________________

Doctor: _______________________________________________________________
Contact Information: ________________________________________________________________

Doctor: _______________________________________________________________
Contact Information: ________________________________________________________________

Doctor: _______________________________________________________________
Contact Information: ________________________________________________________________

Nurse: ________________________________________________________________
Contact Information: ________________________________________________________________

Pharmacist: ____________________________________________________________
Phone number: _______________________________________________________________

24-hour Pharmacy: _______________________________________________________
Phone number: ________________________________________________________________


Return to Document

Current as of April 2011
Internet Citation: Your Medicine: Be Smart. Be Safe. List of Doctors and Pharmacists (DOC). April 2011. Agency for Healthcare Research and Quality, Rockville, MD. http://archive.ahrq.gov/patients-consumers/diagnosis-treatment/treatments/safemeds/yourmedsdocs.html

 

The information on this page is archived and provided for reference purposes only.

 

AHRQ Advancing Excellence in Health Care